What is Silent Reflux?
The word reflux literally means "backflow." Ordinarily, food reaches the stomach by traveling down a muscular tube called the esophagus. The esophagus has two sphincters (bands of muscle that close off the tube) that keep the stomach contents where they belong.
Laryngopharyngeal reflux, or LPR, is the backflow of stomach contents up the esophagus, past the sphincters, and into the throat. The injurious agents in the refluxed stomach contents (refluxate) are primarily acid and activated pepsin, an enzyme needed to digest food in the stomach. The damage to the tissues in the throat caused by these materials can be extensive.
GERD? LPR? What’s the difference?
LPR is different than gastroesophageal reflux disease (GERD). Patients with GERD typically suffer from heartburn and many persons with GERD have esophagitis. Although some persons with LPR do suffer from heartburn or esophagitis (12%), most persons with LPR do not. The reason for this is that the refluxate spends very little time in the esophagus and does most of its damage in the larynx. The anatomic abnormality in patients with LPR is thought to exist at the level of the upper esophageal sphincter. Esophageal motility and esophageal acid clearance are usually normal. The esophagus is very well equipped to handle small amounts of reflux and little, if any esophageal injury occurs in patients with LPR. Because patients with LPR do not suffer from heartburn, the diagnosis may be difficult to make for some clinicians.
Common Symptoms of LPR:
- Asthma-like symptoms
- Bad/bitter taste in mouth
- Chronic cough
- Frequent throat clearing
- Pain or sensation of lump in throat
- Post-nasal drip
- Problems while swallowing
- Referred ear pain
- Singing difficulties
LPR is diagnosed by clinical history, physical examination, and, sometimes, by special testing. A history of characteristic symptoms directs the physician to look closely for tale-tale physical exam findings to support the diagnosis. These findings may include: redness or irritation of the larynx (the voice box area), swelling in the larynx, or reactive growths (called granulomas). A special test called a 24-hour pharyngo-esophageal pH probe study may be ordered to accurately document reflux events, which are occurring. Most of the time, the diagnosis is confirmed by a positive response to a trial of medication and lifestyle modification